New clinical data on human spinal cord re-irradiation tolerance.
New clinical data on human spinal cord re-irradiation tolerance.
复制标题
人类脊髓再辐射耐受性的新临床数据。
DOI：
10.1007/s00066-021-01772-7
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Nieder C
中科院分区：
文献类型：
--
作者：
Doi H;Tamari K;Oh RJ;Nieder C
提供脊髓再照射耐受性的临床资料。这是一项回顾性双机构研究，研究对象为颈部或胸部脊髓再次辐照的患者，至少随访6个月。确定最大剂量（Dmax）和0.1 cc剂量（D0.1 cc）（磁共振成像[MRI]定义的脊髓），并表示为2-戈伊分次的等效剂量（EQD 2），α/β值为2戈伊。所有32例患者在中位随访12个月后均未发生放射性脊髓病。在6-97个月（中位数15）后进行再照射。22例（69%）再照射脊髓EQD_2 Dmax高于第一疗程。64个疗程中的48个疗程采用了2.5至4戈伊的剂量至靶体积。脊髓EQD 2 Dmax中位累积值为80.7戈伊，最小值为61.12戈伊，最大值为114.79戈伊。脊髓D0.1cc EQD 2累积剂量中位数为76.1戈伊，最小值为61.12戈伊，最大值为95.62戈伊。除累积剂量外，还存在其他脊髓病风险因素（9例患者的单疗程Dmax EQD 2 ≥51戈伊，5例患者的单疗程D0.1 cc EQD 2 ≥51戈伊）。即使患者接受的累积剂量高于先前推荐的剂量，或根据已发表的风险评分，具有相当大的脊髓病风险，但仍然没有发生这种并发症，尽管必须承认目前存活患者可能出现损伤，即，仍然处于危险之中在获得适当的知情同意后，个体化决定重新照射是一种可接受的策略，包括脊髓低再照射剂量将损害靶区覆盖率和肿瘤控制概率到不可接受程度的情况。
To provide additional clinical data about the re-irradiation tolerance of the spinal cord. This was a retrospective bi-institutional study of patients re-irradiated to the cervical or thoracic spinal cord with minimum follow-up of 6 months. The maximum dose (Dmax) and dose to 0.1cc (D0.1cc) were determined (magnetic resonance imaging [MRI]-defined cord) and expressed as equivalent dose in 2‑Gy fractions (EQD2) with an α/β value of 2 Gy. All 32 patients remained free from radiation myelopathy after a median follow-up of 12 months. Re-irradiation was performed after 6–97 months (median 15). In 22 cases (69%) the re-irradiation spinal cord EQD2 Dmax was higher than that of the first treatment course. Forty-eight of 64 treatment courses employed fraction sizes of 2.5 to 4 Gy to the target volume. The median cumulative spinal cord EQD2 Dmax was 80.7 Gy, minimum 61.12 Gy, maximum 114.79 Gy. The median cumulative spinal cord D0.1cc EQD2 was 76.1 Gy, minimum 61.12 Gy, maximum 95.62 Gy. Besides cumulative dose, other risk factors for myelopathy were present (single-course Dmax EQD2 ≥51 Gy in 9 patients, single-course D0.1cc EQD2 ≥51 Gy in 5 patients). Even patients treated to higher cumulative doses than previously recommended, or at a considerable risk of myelopathy according to a published risk score, remained free from this complication, although one must acknowledge the potential for manifestation of damage in patients currently alive, i.e., still at risk. Individualized decisions to re-irradiate after appropriate informed consent are an acceptable strategy, including scenarios where low re-irradiation doses to the spinal cord would compromise target coverage and tumor control probability to an unacceptable degree.
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DOI：
10.1016/s0360-3016(01)02780-8
发表时间：
2002-04-01
影响因子：
7
作者：
Grosu, AL;Andratschke, N;Molls, M
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DOI：
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DOI：
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影响因子：
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影响因子：
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